CONCEPTS OF REHABILITATION Unit 23

I. Assessment and Documentation Exercise is the most important aspect of a rehabilitation program. A logical and effective rehabilitation program can only be developed after a logical and effective assessment of the injury.

A. Assessment Procedure Mechanism of Injury (what happened; how did it happen) History (ever injured it before, how treated; hear/feel a pop or snap; swell immediately or later on; able to walk on it/continue activity)

A. Assessment Procedure 3. Visual Exam (look for deformity, swelling, open wounds, other abnormalities) 4. Palpation (palpate bones, muscles, and ligaments and check for point tenderness)

A. Assessment Procedure 5. Range of Motion (Passive, Active, Resistive) 6. Special Tests (to determine the extend of damage to a certain structure)

A. Assessment Procedure 7. Muscular Tests (to determine a possible strength deficit) 8. Circulation and Neurological Exam

A. Assessment Procedure 9. Functional Testing (how functional is the body part; can the athlete return to competition)

B. S-O-A-P Notes The findings of the assessment as well as the athlete‘s progress through rehabilitation need to be documented. This is done in form of S-O-A-P notes.

B. S-O-A-P Notes The acronym S-O-A-P stands for: S- Subjective O- Objective A- Assessment P- Plan

1. Subjective Contains information the athlete gives you Detailed information about history of injury & the athlete Chief complaint Signs and Symptoms that you don‘t see

2. Objective Information the ATC finds in his assessment Findings of visual assessment, palpation, special tests Signs and Symptoms you see

3. Assessment Type and severity of the injury Problems associated with the injury (functional deficits; lack of ROM and strength; pain with certain activities)

3. Assessment Goals of treatment are based on the list of problems. Once the ATC identified what needs to be corrected, a plan of action can be developed.

4. Plan Includes what the ATC‘s plan is with the athlete Referral to a physician Treatments Rehabilitation protocol Short and long-term goals

II. Phases of Treatment Goals, (especially short term) of the rehabilitation program are dependent on the extent of the injury and the phases of tissue healing

II. Phases of Treatment Each program will follow a step-by-step progression that first attempts to control the initial response to the injury and slowly works its way to unlimited physical functioning.

II. Phases of Treatment Elements of physical functioning that should be addressed in a rehabilitation program: ROM Flexibility Proprioception

II. Phases of Treatment Muscular strength, endurance, and power Cardiovascular endurance Sport specific functioning

Phases of treatment follow the I-M-P-R-E-S-S program: I - Initial Inflammatory Phase M- Mobility Restoration Phase P - Proprioception Phase R - Resistance Training Phase E - Endurance Training Phase SS- Sport Specific Function Phase

1. Initial Inflammatory Phase Inflammation is the mechanism by which damaged tissue begins to heal. Moderate amount of inflammation is neccesary for haeling; however, too much will delay healing

1. Initial Inflammatory Phase Primary goal: control inflammation (redness, swelling, warmth, and pain) by means of PRICE

2. Mobility Restoration Phase Once the acute inflammatory phase has passed (decrease in swelling, redness, warmth, and pain; improved comfort) mobility needs to be restored. ~ Passive, Active assisted, Active, Resistive

3. Proprioceptive Phase Proprioception refers to the ability of the body to sense the position of its limbs in relationship to the environment and to make quick adjustments accordingly. Example of athlete jumping up and landing on opponent‘s foot...body able t adjust

3. Proprioceptive Phase Good Proprioception will get the right muscles to fire at the right time, thus protecting a joint from injury. Balancing and Coordination exercises

4. Resistance Training Phase Not only the muscles become stronger but surrounding tissues also benefit.

4. Resistance Training Phase The following can be utilized for Resistance Training: Rubber Bands, Manual Resistance, Weight Machines, and Free weights

5. Endurance Phase Cardiovascular endurance should be maintained during the rehabilitation phase without aggravating the injury (pool work-outs, upper extremity bicycle, stanioray bicycle,...)

5. Endurance Phase Muscular endurance can be reestablished by weight training with low amounts of weight and high numbers of repitition.

6. Sport Specific Function Phase Is characterized by activities that mimic those the athlete will encounter on the playing field. Involves running, jumping, cutting, throwing,... . Should progress accordingly to athlete‘s progress.

III. Rehabilitation Exercises A.The foot, ankle, and lower leg

ROM: -writing the alphabet with the foot while hanging off of table (or in whirlpool) -calf stretching

Strengthening: -marble moves -towel crunches, wipes -rubber band exercises (plantar flexion, dorsi flexion, inversion, eversion) -heel raises

Proprioception -single leg balancing -on floor (eyes open and closed) -on half roll -on dyna disk or trampolin -balance board -jumping onto trampoline landing on one foot

Functional -running on treadmill -double leg hops -single leg hops (straight ahead & cross pattern) -running figure 8 (from wide to narrow) -cutting

Group Project: Get into groups of 3-4 Develop a rehabilitation plan including exercises to regain ROM, strength & endurance, proprioception, and functional activities.

You must get all your necessary equipment You must get all your necessary equipment. You will have 15 minutes at the beginning of class to set up on the day of presentation. Each person must equally participate. If you miss presenting with your group you get a zero.

The knee The hip The shoulder The elbow, wrist, and hand The back